For a pulmonary nodule with intermediate probability, which statement about evaluation is true?

• A. CT may be used to assess the lesion initially and evaluate surrounding tissues.
• B. Transthoracic needle aspiration is never used for nodules.
• C. Bronchoscopy is the only method used for peripheral nodules.
• D. Sputum cytology is sufficient to determine malignancy risk.

Answer: (A)

The main idea is that high-resolution CT imaging is the first, noninvasive step to evaluate a pulmonary nodule with intermediate probability. A CT scan defines the nodule’s size, growth, margins, density, and calcification patterns, all of which help distinguish benign from malignant features. It also assesses the surrounding chest tissues—lymph nodes, pleura, and nearby structures—to look for signs of invasion or regional spread that would change management. Based on what the CT shows, you decide whether to monitor with serial imaging or pursue a tissue diagnosis, such as biopsy, or further functional imaging.

Other techniques have roles, but they’re not substitutes for the initial CT: transthoracic needle biopsy can sample peripheral nodules but carries risks like pneumothorax and isn’t always the first step; bronchoscopy is more useful for central lesions and less helpful for small peripheral nodules; sputum cytology alone is not reliably able to determine malignancy risk.